HSE's action against Laya over charges to be fast-tracked
An action by the HSE against Laya Healthcare over the payment of charges for the treatment of private patients in public hospitals has been admitted to the High Court's fast-track commercial list.
The HSE claims the insurer has adopted a position where it believes private patients are to be treated at public rates until the patient signs a document called a Private Insurance Patient (PIP) form.
PIP forms were introduced in 2014 for the purpose of making privately insured patients aware of their entitlements before deciding whether or not to waive their rights to be treated as a public patient.
The dispute arises out of the HSE's interpretation of certain sections of the 1970 Health Act - that once a private patient being treated in a public hospital opts to receive private care then the patient or insurer becomes liable for the payment of charges incurred for the time they spend in the public hospital.
Laya has allegedly taken a view that it should only pay the charges arising after a PIP form is signed.
That interpretation, the HSE claims, means that patients can be billed as both private and public patients during the same stay in a public hospital, depending on the timing of their decision on the PIP form.
The HSE says that Laya's position is not supported by the 1970 Health Act and that the company's actions have caused it to suffer a loss of €20m. It also claims Laya has wrongfully asserted a right to recover money allegedly overpaid to it between 2014 and 2016.
In its action, the HSE seeks various orders and declarations from the court including that under the relevant provisions of the 1970 Act, Laya is liable to pay the prevailing statutory rate for inpatient care provided at public hospitals to patients it insures during the period January 1, 2014, to date.
It also seeks a declaration that, should any patient insured by Laya opt to be treated privately at any point during their public hospital stay, then Laya is liable for the payment of the prevailing inpatient charges for care provided during the entire duration of their stay.
The HSE also seeks, if necessary, orders requiring Laya to repay all illegal deductions made from payments due to public hospitals.
It further seeks an account of all sums it claims are wrongfully held by Laya.
On the consent of both parties, the matter was admitted by Mr Justice Robert Haughton to the Commercial Court yesterday. The case comes back in the new year.